Drug addiction (drug addiction)

Quick Overview

• Description: Physical and / or mental dependence on an addictive substance, loss of control over consumption
• symptoms: compulsive desire to consume the drug (craving) and inability to give it up, loss of control over consumption, tolerance formation, withdrawal symptoms, drug use continued despite negative consequences
• causes: genetic predisposition, social environment, risky personality traits (insecurity, low impulse control), stressful situations, traumas
• Diagnosis: Drug addiction occurs when three out of six addiction criteria are met simultaneously for at least six months.
• Therapy: Detoxification, weaning, promotion of disease acceptance and motivation to abstain, behavioral and group therapy, development of alternative behavioral strategies, uncovering the causes
• Forecast: A drug-free, unpolluted life is possible in principle. However, the addictive memory leaves the dependency lifelong. Untreated, drug addiction leads to health and / or social ruin.

What is drug addiction?

Experts talk about drug addiction (more correctly: drug addiction) when someone is addicted to an addictive substance.

Addictive substances are psychoactive (psychotropic) substances that affect the central nervous system and therefore also thoughts and feelings. They can trigger positive sensations. There is a strong desire for the drug. Physicians call this as so-called “craving”.

The drugs include not only illegal drugs such as cocaine, crystal meth or heroin, but also legal substances such as alcohol, certain drugs and nicotine.

In most cases, a mental dependency first develops, which later gradually changes into a physical one. Some drugs are only psychologically dependent – for example ecstasy. A purely physical addiction, on the other hand, hardly ever occurs alone. An exception are newborns of addicted mothers.

Effect of drugs on the psyche

Addiction physicians distinguish between

• stimulating substances (so-called “upper” such as amphetamines, cocaine and ecstasy),
• depressants (“downers” such as opioids, benzodiazepines) and
• mind-altering substances (hallucinogens such as LSD, hallucinogenic mushrooms and mescaline).

Cannabis and alcohol can have both stimulating and depressing effects and also trigger hallucinations.

Psychoactive substances such as alcohol, heroin or cannabis pass through the bloodstream to the brain where they bind to specific docking sites (receptors) on the surface of nerve cells. This docking triggers various reactions in the brain, for example, the release of the “happiness hormones” serotonin and dopamine. As a result, mood, perception, feelings and thinking can change.

Rausch: The consumer, for example, feels euphoric and intoxicated. The feeling for space and time can also be lost.

Inhibiting effect: Some drugs cause the consumer to seek more contact with others or behave completely uninhibited.

hallucinations: Some drugs trigger hallucinations: the consumer perceives colors, sounds or smells excessively.

Horror trip: Hallucinogenic drugs (such as LSD or magic mushrooms) and sometimes cannabis can also give the consumer a “horror trip” – a drug-induced psychosis characterized by extreme anxiety or panic, intense arousal, and a delusional, paranoid perception. In extreme cases, those affected commit suicide (suicide) in this condition or at least try it.

Effect of drugs on the body

The reactions of the body can be quite different. For example, many drugs cause heart rate and blood pressure to rise and dilate the pupils. This can be seen in some cases drug use. Heroin, on the other hand, does the opposite: blood pressure drops, and the pupils narrow to the size of a pinhead.

Other possible physical reactions:

• Equilibrium and orientation problems
• dry mucous membranes
• constipation
• decreased sexual performance
• difficulties swallowing
• Nausea, vomiting
• feeling cold
• redness
• increased hunger
• decreased alcohol sensitivity
• Certain substances, such as amphetamines, ecstasy, and other stimulants, can also trigger an epileptic seizure and also activate latent (hidden) epilepsy.

Declining drug effect

As soon as the effect of a drug subsides, moodiness and tiredness often set in. Some people sink into a drowsy sleep, others find no sleep despite exhaustion.

development of addiction

That dependence develops from occasional consumption is due to several mechanisms:

Displacement of other life content: Addictive substances can be used to trigger positive emotions and negative emotions. This reduces the motivation to do so through the more arduous, lengthy but healthy way without addictive substances.

conditioning: Formerly neutral situations such as closing time, end of a meal, television, club visit are linked to consumption. They then often automatically trigger a craving for the addictive substance.

Vicious circle: When addictive substances are consumed to escape problems, a vicious cycle is often created: Drug use itself creates additional problems with the environment. They reinforce the desire to escape with the help of the drug.

Habituation: If you regularly resort to an addictive substance, the body gets used to it increasingly. In order to achieve the same effect, the consumer needs ever larger amounts of the addictive substance. In addition, consumption becomes a natural part of life.

Withdrawal symptoms: If a physical or mental dependence sets in, symptoms of withdrawal appear, such as craving for the addictive substance (craving), trembling, restlessness, sweating, depression, anxiety. The addictive substance is then no longer taken in order to achieve a positive effect, but to relieve the withdrawal symptoms.

addiction career

The first addictive substances people come into contact with in western cultures are mostly alcohol and nicotine as legal drugs and cannabis in the area of ​​illegal drugs.

Above all, cannabis is still considered an “entry-level drug”: it should increase the likelihood that the person later takes hard drugs. In fact, almost anyone who tries heroin or crack has previously stoned. Meanwhile, experts are more likely to assume that it is rather the contact with the illegal drug scene, which works here as a door opener.

The same goes for legal drugs: those who are in an environment where a lot of smoking or drinking is more vulnerable. It gets particularly tricky if the following factors are given:

Early consumption – Adolescents who start early with addictive drugs are particularly at risk of becoming addicted. The reason seems to be that the brain is still developing in youth.

Frequency and amount of consumption – Those who rarely drink and drink little alcohol will probably never cross the critical threshold to addiction. It is different with intensive or very frequent consumption.

Type of addictive substance – Some addictive substances are extremely fast dependent. This includes nicotine!

Drug addiction: symptoms and diagnosis

Doctors know six typical signs of drug addiction. Every single one is a clear warning signal. If three of the mentioned drug addiction symptoms occur at the same time, it can be recognized by a drug addiction.

• Craving: Strong, sometimes irresistible desire to take the substance.
• Loss of control: To control the timing, duration and amount of consumption. Attempts to permanently restrict consumption fail.
• Withdrawal symptoms: mental and physical withdrawal symptoms
• Development of tolerance: For the same effect, an ever higher dose is needed.
• Neglect of interests and tasks: Procurement, consumption and recovery from intoxication are increasingly the focus of attention. Other interests and obligations are neglected.
• Consumption despite negative consequences for health, work, social life

Causes of drug addiction

Whether and how an addiction develops depends on various factors – genetic, social and psychological.

Genetic factors

How high the risk of an addiction, the genes determine decisively. For example, they influence how addictive substances affect the body and the psyche. However, addiction is not an inevitable fate even with a strong genetic predisposition.

Mental factors

Drugs have an effect on the psyche: They help to escape, quench fears, worries and sorrows, stimulate or soothe. Those who are particularly stressed and / or have little healthy strategies to deal with problems and stress are more at risk of addiction. A typical “addictive personality” does not exist.

Other psychological factors that increase the risk of dependency include:

• psychological injuries (eg lack of care, violence and abuse)
• mental illnesses such as anxiety and depression
• low self esteem

Social factors

The social environment also plays a central role in addiction development. How easy do you get the substances? How normal is it in the environment to consume addictive substances? Is there even a social pressure to consume?

Family role models: If children and adolescents regularly consume legal or illegal drugs, they are more likely to later become addicted themselves. This is especially true when dealing with problems or conflicts with drugs.

Peer group: When the best buddies consume cigarettes, alcohol, or illegal drugs, the desire to be a part of them may turn the onset into an addiction.

Social isolation: Loneliness is also a crucial factor in escaping into an addiction. Alcoholism and sedative dependence are often based on social isolation, lack of contacts, lack of attention and recognition. A stable social network protects against addiction.

Drug Addiction – Therapy

The aim of the drug therapy is to wean the organism from the addictive substance by removing it (drug withdrawal) and ideally to achieve long-term abstinence.

While the physical detoxification is done in a few days, mental weaning proves tedious. It can take months to years. The mental withdrawal symptoms include restlessness, anxiety, depression, suicidal thoughts and “craving” – the strong craving for another dose of the addictive substance (addiction pressure).

Drug Addiction – Seek Help!

Fighting drug addiction without resorting to therapy is usually doomed to failure. It is therefore important that you seek professional help with drug addiction. The therapy then generally proceeds as follows:

Step 1: Motivation phase

In the motivational phase, the addict usually still consumes drugs. The goal is to strengthen or build up the motivation for a drug therapy. This takes the form of counseling sessions, one-to-one conversations and usually also in group sessions. Only if the appropriate motivation is given, the withdrawal can succeed permanently.

Motives for a withdrawal can be for example:

• Preservation of partnership, friendships
• Right of access with one’s own children
• Maintaining the workplace, finding a job
• Regaining the license
• Stabilization, maintenance or recovery of health
• Life independent of addictive substance
• sentence reduction

Step 2: Detoxification

As part of the physical drug withdrawal, the organism is first detoxified. Just a few hours after the last drug dose, depending on the substance, various symptoms may occur. The physical withdrawal symptoms peak 24 to 48 hours after the last drug dose.

The extent and type of physical and mental withdrawal symptoms depend on the drug used and the severity of the dependency. They are also different from person to person. Examples of withdrawal symptoms:

• sweats
• Tremble
• nausea
• stomach cramps
• palpitations
• Circulation problems
• delirium

Life-threatening is the so-called delirium, which can cause hallucinations and may be accompanied by severe seizures.

Outpatient or inpatient?

The physical drug withdrawal is a risky health situation and is therefore usually carried out inpatient (such as in the hospital or in special detoxification hospitals). There, the drug addict can be looked after and supported by experienced professionals – experts speak of “qualified detoxification”.

In the case of less powerful drugs and less severe dependency, the withdrawal can also take place on an outpatient basis.

Methods of withdrawal

There are different ways of withdrawal. In all, the will of the person concerned to free himself from his dependency is the most important prerequisite for participation and success.

Detoxification without medication (“cold” withdrawal)

Here the addictive substance is discontinued abruptly. The occurring and sometimes severe withdrawal symptoms must “sit out” the addict without medical help. Instead, the drug withdrawal is often supported by accompanying measures such as physical therapy, acupuncture or relaxation procedures. The “cold” withdrawal usually lasts one to two weeks.

Drug-based detoxification (“warm” withdrawal)

With drugs in this form of drug withdrawal the withdrawal symptoms are alleviated. Sedative antidepressants (such as doxepin), clonidine (relaxes the blood vessels and reduces blood pressure) and neuroleptics (sedative substances that are also used to treat psychosis) are used. However, if you take more than one medicine, you may experience unwanted interactions. The “warm” drug withdrawal extends over about twenty days.

Opioid-based detoxification (substitution therapy)

Heroin addicts are prescribed a different opioid as a replacement for the drug, the dosage of which is then usually gradually reduced. Methadone is usually used for this substitution. It relieves the withdrawal symptoms, but does not produce a intoxicating effect.

In the long term, however, methadone can make dependent, which should prevent the slow dose reduction. The concept of “drug on prescription” should also reduce the negative effects of addiction (for example, drug crime) and facilitate the return to the “normal” life and work.

The methadone program, however, is open only to heroin addicts whose addiction career has existed for more than two years and in whom previous treatment attempts have failed. And here, too, will be decided case by case. The program is usually limited to six to twelve months (sometimes longer); only in severe physical diseases such as HIV or cancer, some sufferers receive the methadone permanently.

Forced detoxification (“turbo-withdrawal”)

It is only used for opioid dependence (for example heroin, morphine). The patient undergoes an accelerated drug withdrawal in the ICU within a few hours and under anesthesia.

For this purpose, he is administered via a nasogastric tube an opiate antagonist – a substance that occupies the same docking sites on the nerve cells as the drug used, so that they can no longer bind and unfold their effect. However, this does not make you “clean”, but only avoids the acute withdrawal symptoms or at least greatly shortens them in time.

The turbo withdrawal is not suitable for multiple dependencies (especially with additional cocaine use). Excluded is the simultaneous use of so-called benzodiazepines (a drug group of sedatives and sleeping pills).

Step 3: Weaning

After the detox comes the weaning. In particular, overcoming mental dependency takes time. There is no “schema F”, every addiction story is unique and needs individual ways to treat it. The weaning therapy focuses on the following topics:

• Clarify causes: Where are the roots of addiction? Which function does the addictive substance fulfill? B. Stimulation, reduction of tension, reduction of anxiety? Which behavioral and thought patterns keep me trapped in addiction?
• Build alternative behavioral strategies: How can I design my life so that I can do without the addictive substance? What alternative behaviors are there?
• Strengthen motivation: What advantages does a life without an addictive substance offer me?
• Stress reduction: Recognize and reduce stress triggers, learn targeted relaxation techniques.
• Prevent relapse: Recognize individual signs and counteract them in good time. A mindfulness training can be helpful here.
• reintegration: Support for reintegration into social life and working life.

The weaning therapy is often carried out as part of a rehabilitation program for hard drugs and advanced addiction in specialty hospitals. An outpatient weaning treatment is possible if the patient is still well embedded in social or work life and can cope with the required abstinence without the protection of a clinic. The weaning treatment lasts six to nine months, longer on an outpatient basis.

The therapy includes single therapeutic care as well as group sessions. The latter provide the experience that drug addiction can affect anyone, as well as empathy with people who are also affected, and inspiration from the different coping strategies of those affected.

Optionally, weaning also includes further drug treatment (e.g., with opiate antagonists).

Step 4: Stabilization

After successful weaning ideally a stabilization phase follows. This can be done by a resident therapist and / or as part of self-help groups. The point here is not to lose sight of the goal of abstinence in everyday life and to prevent relapses.

Consequences of drug addiction and prognosis

A prognosis is very difficult to set for a dependence disorder. For example, it depends on how long and how seriously the person is already addicted to addiction, how quickly and strongly the addictive substance makes them dependent.

Decisive for the success of the therapy are

• the of insight – So the consciousness of the person affected to suffer from a treatment-needy addiction
• a strong motivation to exit the addiction
• regular participation in an addiction treatment program therapy program
• a long-term participation in subsequent stabilization measures

Late effects of drug use

Long-term drug harm depends on several factors. These include the type of addictive substance and the frequency and duration of drug use. The following, sometimes severe damages can cause drug use:

• Liver damage (eg liver cirrhosis, liver cancer)
• other cancers
• Damage to nerves and brain to dementia
• Diseases of the gastrointestinal tract (eg stomach ulcers)
• chronic or acute inflammation of the pancreas (pancreatitis)
• Damage to the heart and circulatory system
• mental illness, z. Schizophrenia, depression
• permanent loss of performance, concentration problems
• premature aging of the skin